MedPAC's June 2026 report to Congress dropped on June 15 and attached $22 billion in higher-than-justified Medicare Advantage payments in 2026 to coding intensity alone. The same report documented $23.7 billion in improper MA payments for fiscal year 2025 and endorsed a federal role for technology in fixing Medicare enrollment, in the same chapter that flagged the broker channel as part of the problem the technology is meant to solve.

In this episode of the Upward Growth Podcast, Ryan Peterson walks through how the three MedPAC findings change the procurement conversation inside MA plans for the rest of 2026. The episode goes past the article to spend time on why the risk adjustment buyer profile has shifted on both sides of the CMS intensity adjustment, what the WISeR Model means for the AI utilization management category, and three live questions over the next 90 days that will shape what plans buy in 2027. Vendors hear which version of the buyer they're actually selling to. Investors hear which sub-segments of the MA market and which vendor categories are getting repriced. Health plans hear how the report sorts their peers and what their procurement counterparts are now being asked to defend.

What you'll hear:

• Why MedPAC's three findings, read as one document, change who the buyer is inside the plan for risk adjustment, utilization management, and member experience
• How the half of MA plans coding above the CMS intensity adjustment and the half coding below it are operating differently in 2026
• Why compliance, legal, and the CFO are now at the risk adjustment vendor table on both sides of that line
• What the WISeR Model means for the AI utilization management category, now that CMS itself is the buyer under a shared-savings contract
• How the June 17 CMS guidance memo on the 2027 Quality Bonus Payment ratings reshapes the ROI conversation around member experience investments
• Three things to watch over the next 90 days: the CMS appeal on Clover, the eviCore strategic review outcome, and the RADV extrapolation methodology

Read the full analysis in the Upward Growth newsletter: Three Things MedPAC Just Told Congress That Will Change What Health Plans Buy

About Upward Growth: Upward Growth is a health plan market advisory firm. We work with health tech vendors, investors, provider organizations, and management consultancies on how health plans actually buy, operate, and make decisions.

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Connect with Ryan on LinkedIn: https://www.linkedin.com/in/ryan-peterson-1a20866/

Learn more about Upward Growth: https://www.upwardgrowth.com